Patient perceptions of second eye clear corneal cataract surgery using assisted topical anaesthesia

Abstract

Aim To assess patient recall of intraoperative pain, anxiety, fear, and sensory (visual and auditory) perceptions during second eye clear corneal cataract surgery using assisted topical anaesthesia (ATA), in comparison with first eye cataract surgery using the same technique. Methods This prospective, consecutive, observational study was conducted in a free-standing dedicated ophthalmic day surgery centre. A voluntary questionnaire was distributed to 129 consecutive patients who underwent clear corneal cataract surgery using ATA. Two patients had to be converted to block anaesthesia, and were excluded. Patients were asked to rate intraoperative pain, anxiety, and fear using a visual analogue scale (VAS), and recollection of intraoperative visual and auditory perceptions. Results were analysed using the Mann-Whitney U and Spearman correlation tests. Results There were 70/127 (55%) patients undergoing first eye cataract surgery and 57/127 (45%) undergoing second eye surgery. There was no significant difference in mean pain, anxiety, and fear scores between those undergoing the second eye operation compared with those undergoing their first eye operation. Similarly, there was no significant difference in sensory perceptions between the two cohorts. Overall, there was a small but significant positive correlation between recall of visual and auditory perceptions and combined pain, fear, and anxiety scores (r ¼ 0.33, P ¼ 0.0002). Conclusion There was no significant difference in levels of intraoperative pain, anxiety, fear, and sensory perceptions experienced by patients between the first eye and second eye surgeries. We recommend that preoperative counselling for a patient's second eye be as comprehensive as for the first eye surgery.

Pain during second eye cataract surgery under topical anesthesia: an intraindividual study

“…A common observation among ophthalmic surgeons is that patients often complain about more pain or ocular discomfort as they undergo ophthalmic procedures in their second eye when compared to the first. This issue has been reported both in cataract [4] and, although not being specifically addressed, in refractive surgery patients [5].…”

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

“…Similar observations have been published by other authors. 8,9 Although fear did appear to be associated with the first eye surgery in these studies, once again it failed to reach statistical significance.…”

Ophthalmological aspects of the effect of selected physical, chemical and biological agents

“…Albeit, some examiners concluded that second eye surgeries would be more painful (6,20), others including us have could not find difference in the intaoperative pain between the consecutive surgeries for a patient (2,15,16,21). As the length (and complexity) of the procedure is of no influence on the pain sensitivity (55,57), the duration of the surgeries was not recorded.…”

“…Data always were obtained from each patient's both eyes procedures (otherwise excluded) consequently, the compared groups did not differ in either age, gender, education level, psychological characteristics or racial distribution. Similar studies (6,16,21) in contrast, compared independent groups of patients undergoing the first and second eye PhEs, moreover the procedures were done by different surgeons. Taking into consideration, that a patient complaining about more pain or unpleasantness by the second eye surgery, actually he or she compares the recently perceived pain with the remembered pain of the first procedure, we decided to try to estimate the remembered pain of the procedures as well.…”

“…The relating literature seems to be of controversy as to the pain for sequential cataract surgeries. While several authors reported on higher pain scores among the patients undergoing surgery for their second eyes (6,20) others did not find correlation between the level of pain perception and the sequence of operation (7,16,21). To look into the problem in another way, we conducted a single centre, single surgeon prospective study (Study 1.)…”